Medicine and Health Sciences Commons^™

Cultural Competency Training In Primary Care: A Pilot Project For Improving Culturally Competent Care, Diane F. Riff

Doctor of Nursing Practice Projects

As America grows increasingly diverse, there is a recognized need for increased cultural competence in Nurse Practitioners (NPs) and other healthcare workers. Research has shown that when health care providers are not attentive to providing culturally competent care, there is a subsequent negative impact on the quality, safety and cost of patient care. Cultural

competency is a recognized and popular approach to improving the provision of health

care to racial/ethnic minority groups in the community with the aim of reducing health disparities in racial/ethnic minorities. The project sought to improve NPs’ and other health care workers’ abilities to provide culturally …

Utilizing Simulation For Family Member Caregivers Of Nicu Infants: A Pilot Project, Brenda M. Seegmiller

Doctor of Nursing Practice Projects

According to the World Health Organization (WHO), there are approximately 15 million babies born prematurely every year. Family members of premature infants in the Neonatal Intensive Care Units (NICU) are overwhelmed and lack confidence with basic skills to care for their newborn. Simulation is an education modality used for adult learners that utilizes a hands-on method for education and allows application of knowledge and skill development in a safe environment. Although clinicians are frequently trained utilizing simulation, there is limited information on its use among family members and caregivers. The purpose of this DNP Project was to explore use of …

Colorectal Cancer Educational Program In A Community Senior Center, Cathy A. Catlett Dr.

Doctor of Nursing Practice Projects

Colorectal cancer (CRC) is a preventable cancer but prevention can only occur through screening. Screenings are recommended for those 50 to 75 years of age, however rates remain low with 25.6 percent having never been screened and 7.1 percent not up-to-date. The U.S. Preventive Services Task Force (USPSTF) recommends strategies such as education to increase screening rates. Education may be used to inform and motivate individuals to be screened. Research supports the use of educational activities in a community setting to increase CRC knowledge and increase CRC screening rates. A group educational program using the Centers for Disease Control’s (CDC) …

Mobile Video Monitoring To Reduce Falls And Sitter Usage, Jennifer L. Forman

Doctor of Nursing Practice Projects

In the United States between 700,000 to 1,000,000 people fall in hospitals each year. Reducing patient falls in the inpatient setting remains a challenge for many acute care hospitals. Inpatient falls can lead to serious injuries such as fractures and internal bleeding. Fall-related complications can lead to increased hospital stay, prolonged rehabilitation, and increased healthcare costs. Inpatient falls are considered preventable. One intervention commonly used to prevent falls and keep patients safe is the use of an in-person sitter or a patient safety companion (PSC). However, sitters are very costly and considered a variable staffing resource. The need for a …

The Impact Of A Revised Discharge Process From Acute Care To Home Care On Hospital Utilization In Children With Single Ventricle Heart Disease, Brian M. Stahulak

Doctor of Nursing Practice Projects

Problem Description: It is estimated that approximately ~0.5%, or ~400,000, of all U.S. children, are identified as having complex chronic conditions (CCC) and account for as much as one-third, or ~$100 billion, of health care spending for all children. The goal of this quality improvement (QI) project was to identify the impact of a revised discharge process for children with Single Ventricle Heart Disease (SVHD) on hospital utilization rates and the parent’s perception of discharge readiness during the interstage period. The QI project was conducted in a 44-bed cardiac care unit within a 336-bed freestanding pediatric, academic medical center in …

Awareness Matters: Improving Healthcare Workers’ Self-Efficacy, Knowledge, Skills And Attitudes Related To Mental Illness And Suicide Prevention, Carlana J. Coogle

Doctor of Nursing Practice Projects

Problem Description

Healthcare workers’ (HCWs) negative stigmas, poor attitudes, and lack of knowledge impact the care delivered to patients with a mental illness or who may be suffering with suicidal thoughts.

Rationale

Raising HCWs’ awareness, knowledge and skills have been linked to improving the negative stigmas, biases, and attitudes that impede the care required to achieve optimal health outcomes.

Intervention

Participants attended a 90-minute Question, Persuade, Refer (QPR) gatekeeper training, each participant received six bi-weekly emails about mental health issues, suicide prevention, and community resources. A pre/post survey design using the Mental Illness Clinicians’ Attitude Scale (MICA-4) and the Mental …

A Psychoeducational Support Group For Family Caregivers Of Elders With Major Neurocognitive Disorder/ Dementia, Brooke D. Katz

Doctor of Nursing Practice Projects

Background: Dementia is a major public health problem impacting an estimated 65.7 million people worldwide by 2030. It primarily occurs in the elderly population (over age 65) and also affects family caregivers, who often experience significant stress and burden. A psychoeducational support group may be an easy and cost-effective solution to caregiver stress and financial burden.

Objective: To determine whether or not there is an effect on self-reported stress and burden on family caregivers of elders with dementia (EWD) of a voluntary psychoeducational support group in the setting of Assisted Living, Memory Support, and Skilled Nursing led by a psychiatric …

Primary Care Panel Comanagement By A Physician And An Advanced Practice Clinician: Impact On Provider Burnout, Jennifer Strobel

Doctor of Nursing Practice Projects

Background: Levels of burnout have reached epidemic proportions among health care professionals, resulting in a number of negative consequences, including loss of productivity, increased turnover, and increased organizational costs. Advanced Practice Clinicians (“APCs”- a term that encompasses both ARNPs and PAs) were integrated into teams with physicians at a network of primary care clinics in a greater metropolitan area in the United States with the goal of reducing provider burnout. This approach has not yet been evaluated to determine whether there are benefits for reduction of burnout levels in clinicians. Few studies have been conducted to date about the …

Improving Sexual Orientation And Gender Identity Knowledge In Convenient Care Clinics: A Toolkit And Competency Training For Caregivers, Elizabeth M. Gallagher

Doctor of Nursing Practice Projects

It is well documented that transgender individuals experience higher rates of discrimination than non-transgender, also known as cis-gender, individuals (Scandurra, Amodeo, Valerio, Bochicchio, & Frost, 2017). This discrimination extends into the healthcare system, a place where all individuals should be treated with dignity and respect (Bauer, Scheim, Deutsch, & Massarella, 2014). Over the last few decades, cultural humility has been promoted in health care professional training (Fisher-Borne, Cain, & Martin, 2015; Tervalon & Murray-Garcia, 1998). However, transgender care is rarely included. This lack of training can lead to a decreased confidence in providing care to transgender individuals and poor experiences …

Improving Infection Management Of The Institutionalized Elderly, Jovel Angela Viloria Broqueza

Doctor of Nursing Practice Projects

Abstract

As the elderly population rapidly grows in the United States, the burden of managing infection in long-term care facilities (LTCF) escalates. The use of evidence-based infection identification algorithms for early recognition and treatment of pneumonia, urinary tract infections (UTI) and skin and soft tissue infections (SSTI) was evaluated at a Midwest suburban 110-bed long-term care facility. Focus group sessions were conducted at the facility with four nurse practitioners, the medical director, eight nurses and certified nursing assistants (CNAs) prior to an educational in-service which was provided to all staff at the facility. As criteria of infection were reported, nurses …

Overcoming Barriers For The Implementation Of Evidence-Based Practice Through Journal Clubs, Regina Thomas

Doctor of Nursing Practice Projects

Many barriers exist at a 134-bed rural hospital in southern Illinois that hinder generation, evaluation, and implementation of evidence-based research into practice. This DNP project was completed through a phase approach utilizing a modified version of Kotter’s Model of Change, the RNcEBP Survey to self-rate individual confidence in the EBP process, and the Iowa Model of Evidence-Based Practice to facilitate implementation of journal clubs. The RNcEBP survey revealed that nurses were familiar with the concept of EBP, have positive attitudes, and are confident that EBP changes can improve patient outcomes, but lack experience in evaluating literature to support implementing evidence-based …

Transitioning With Grace: Improving Quality Of Life For Comfort Care Patients In The Intensive Care Unit, Melissa Ashley

Doctor of Nursing Practice Projects

The primary aim of this project was to develop and execute a standard protocol of interventions for comfort care patients on a medical intensive care unit. Staff at a 15 bed MICU at a Midwest urban teaching hospital from June 1 until August 11, 2018 were trained to execute a standardized protocol of interventions for comfort care patients. Seventeen MICU patients who transitioned to comfort care were offered a standardized set of evidence-based interventions, after staff attended educational in-services on providing high quality end of life (EOL) care. Checklists were used to determine intervention compliance. Pre-project and post-project surveys were …

Implementation Of High Blood Pressure Guidelines In Clinical Practice, Jessica Walker

Doctor of Nursing Practice Projects

Abstract

This quality improvement project implemented 2017 Guidelines for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. An in-service education session on the 2017 High Blood Pressure Guidelines was provided to clinical staff. In addition, the AHA/ACC pooled cohort 10-year risk calculator was installed to computer desktops or smart phones, for providers. “Seven simple tips to get an accurate blood pressure reading” (American Medical Association, 2016) was posted in exam rooms and proper measurement and documentation techniques were reviewed with clinical staff. Review of recommended non-pharmacological treatment methods with proper patient education documentation was also conducted. …

Strong Recommendation Towards Hpv Vaccination, Danielle Bogue

Doctor of Nursing Practice Projects

Risk of future HPV related cancers remains high in individuals unvaccinated against HPV, leading to too many people dying from this preventable cancer. However, primary care providers’ strong recommendation to vaccinate and family education about HPV and vaccine efficacy have a positive impact on a family’s decision to vaccinate. The setting for this project was a Midwest suburban family healthcare practice. This process was implemented by providing the guardian with a handout, a short video on HPV, a question and answer period with the provider, and ended with the provider giving a strong recommendation towards HPV vaccination. Of the 35 …

Factors Contributing To 30-Day Readmission In Postsurgical Patients: A Reevaluation Of Hospital Policies And Proposal For Change, Miriam Morgan-Skinner

Doctor of Nursing Practice Projects

Background

Readmission can cause much frustration for patients and families. The Center for Medicare and Medicaid Services (CMS) has emphasized the importance of finding ways to decrease readmissions within 30 days of discharge. In the southwest healthcare organization studied, the 30-day readmission rate for abdominal surgeries was 10%. The goal of the study was to identify the causative factors for the readmissions and make appropriate suggestive changes. This project identified the factors contributing to the 30-day readmission rate in selected abdominal surgeries between January 2016-July 2017 and developed a policy to address the predominant factor.

Method

After receiving institutional review …

Evaluation Of Cardiomems Heart Failure Device, Danielle Moe, Msn, Rn

Doctor of Nursing Practice Projects

Background: Heart failure (HF) is a chronic condition where the heart cannot pump enough blood to adequately oxygenate cells. The CardioMEMS HF device is implanted into the pulmonary artery (PA) allowing practitioners to monitor pressures remotely and prescribe interventions. Objectives: The primary purpose of this project was to determine if CardioMEMS is an effective intervention in the reduction of hospital admissions, emergency department (ED), and clinic visits for HF patients. The secondary purpose was to determine if the quality of life (QOL) and exercise tolerance was improved post-implant. Methods: The author conducted a retrospective chart review by accessing previously compiled …

Relationship Between Shift Hours Worked (12 Versus 8), Workload, And Nurses' Burnout: A Study Across Acute Care Units In A Community Hospital, Liliane Nyamuziga

Doctor of Nursing Practice Projects

Nurses are expected to provide quality care to patients, and work demands in the health care system are increasing. An increased turnover in nursing staff was observed in a southwest Michigan community hospital, and the possibility of burnout contributing to this turnout was proposed. The purpose of this scholarly project was to evaluate the significance and level of perceived burnout in nurses who work the 12-hour shift compared to those who work the eight-hour shift, to investigate the relationship between nurse-to-patient ratios and burnout, and to compare burnout levels between nurses working day versus night shifts. This project utilized a …

Using An Educational Session To Improve The Knowledge, Confidence, And Beliefs About Psychopharmacology For Behavioral Health Clinicians, Sharon Bennett

Doctor of Nursing Practice Projects

Background: Psychiatric illness is unpredictable, has spasmodic tendencies, and represents one of the most reported types of disabilities in the United States. Behavioral health clinicians are front line respondents and considered a major ally to providers by supporting medication management recommendations and referring new patients for medication management. Basic evidence-based psychopharmacology improves behavioral health clinicians’ knowledge, however, is inadequate in curricula, and many undergraduate and graduate programs lack one dedicated psychopharmacology class. This abbreviated knowledge contributes to inadequate referrals for treatment and poor confidence in supporting the practitioners’ medication recommendations.

Method: This project examined behavioral health clinicians’ knowledge, confidence, and …

Adult Naloxone Administration Protocol, Samuel S. Adhikari

Doctor of Nursing Practice Projects

Abstract

A tertiary care facility in central Illinois noted an increase in inpatient opioid-related adverse events, including acute opioid withdrawal syndrome due to a higher than a necessary dose of naloxone. The patient required intubation with a prolonged intensive care unit stay. A naloxone administration protocol encouraging cautious titration of naloxone could potentially decrease, if not entirely avoid similar events. When a patient exhibits opioid overdose symptoms, airway management, hemodynamic support, and due appreciation of the elimination half-life of naloxone become vital in preventing potentially tragic outcomes. This quality improvement project was non-experimental and involved the design and introduction of …

Enhanced Recovery After Orthopedic Surgery In Total Hips And Knees, Christine Rigg

Doctor of Nursing Practice Projects

The prevalence of total knee and hip replacement surgery is increasing related to a combination of factors including osteoarthritis, age, and obesity (Christelis et al., 2015). The increased demand for joint replacement, current cost, and length of stay (LOS) place an increasing burden on clinical and financial resources. Enhanced recovery after surgery (ERAS) protocols have facilitated improved outcomes, such as increased patient satisfaction, decreased LOS, and associated costs (Bernard & Foss, 2014; Husted, Holm, & Jacobsen, 2008). Development and subsequent anesthesia group education were the beginning steps toward orthopedic protocol implementation in this project. This practice project had two goals: …

A Retrospective Analysis Of An Opiate Education And Naloxone Distribution Program, Ashley M. Tyler

Doctor of Nursing Practice Projects

Abstract

Trends indicate that misuse of opiates has increased nationally, frequently resulting in death. Substance use treatment clinics are now distributing naloxone (Narcan) to clients and laypeople as an antidote for opiate-related overdose. Offering Opiate Education and Naloxone Distribution (OEND) programs at treatment facilities increase the naloxone education opportunities available to those most closely affected by overdose.

Methods: The evaluation of naloxone distribution at a Midwestern substance use disorder clinic involved a retrospective analysis via chart audit of data regarding the delivery and administration of naloxone. The project focused on 48 individuals in the initial treatment phase for opiate use …

Developing An Online Wellness Curriculum For Nurse Anesthesia Students, Gina Calvanese, Jamie Rynearson

Doctor of Nursing Practice Projects

Student Registered Nurse Anesthetists (SRNAs) begin graduate school as confident critical care nurses, unaware of the impact that constant, daily stress will have on their lives. Wildgust (1986) presented the earliest known research and concluded stress negatively impacted the physiologic wellbeing of SRNAs. It has been reported that students in anesthesia programs experiencing high levels of stress and burnout are more likely to make critical errors when caring for their patients (de Oliveira, 2013). The goal of this doctoral project was to promote wellness and stress management among students enrolled in Southern Illinois University Edwardsville’s Nurse Anesthesia program by proposing …

Promoting Antibiotic Stewardship For Uti Management In Long Term Care Residents Through Standardized Clinical Practice Guidelines., Juliana M. Enoakpa

Doctor of Nursing Practice Projects

Urinary tract infections (UTIs) are the most diagnosed infections requiring antibiotics in long-term care (LTC) facilities. The rising prevalence of antimicrobial resistance (AMR) threatens treatment of infections that were once responsive to antibiotic therapy. The inappropriate use of antibiotics in this Midwestern LTC facility provided the impetus for implementing a standardized clinical practice guideline (CPG) for diagnosing UTIs among the LTC residents. A data collection tool was developed for the audit that identified the specific assessment criteria for UTI management and eligibility criteria for antibiotics. Physicians and NPs at the LTC facility were administered a questionnaire prior to implementation of …

Standardized Patient Handoff Tool, Matthew Marten

Doctor of Nursing Practice Projects

Patient handoffs are defined as the transmission of information and accountability between teams and individuals. These handoffs can be periods of increased risk for the patient and increased errors among anesthesia providers and PACU nurses (Segall et al., 2012). The Joint Commission recommends healthcare providers improve patient handoff as a national goal (Robins & Dai, 2015). The purpose of this nursing doctoral project was to determine if using a standardized patient handoff tool could improve communication and satisfaction between anesthesiologists, CRNAs, and PACU nurses. A review of the current literature supported the need for a standardized patient handoff tool for …

Diabetes Education, Audra Trump

Doctor of Nursing Practice Projects

Background: Diabetes Self-Management Education (DSME) has been shown to improve diabetes management. However, a Midwest academic clinic does not offer formal diabetes education. The health department offers formal diabetes education classes twice a year. However, the classes are not flexible, long, and offered infrequently. Objective: The purpose of this project is to improve access to and standardize DSME for patients newly diagnosed with type II diabetes. Methods: The project design includes a one group pre-test/post-test convenience sample of adult patients who are newly diagnosed with type II diabetes in an academic outpatient setting. Results: At the time of diagnosis, the …

Local Anesthetic Systemic Toxicity Management: An Assessment Of Simulation-Based Staff Education, Kevin L. Kanallakan

Doctor of Nursing Practice Projects

When local anesthetics are administered at toxic doses or when certain local anesthetics are directly injected into the patient’s circulation, excessive plasma concentrations of the drug will produce a systemic cascade of events known as local anesthetic systemic toxicity (LAST). LAST is a rare, potentially life-threatening complication, which affects both the central nervous and cardiovascular systems. Anesthesia providers and perioperative healthcare professionals must remain current on best practice LAST management in order to reduce morbidity and mortality.

This quality improvement project utilized high fidelity simulation paired with LAST education to improve stakeholder knowledge and management of a LAST scenario. With …

Assessment Of The Validity Of Patient-Stated Allergies: De-Labeling And Education, Tawny Thomas, Angelina Leitschuh

Doctor of Nursing Practice Projects

The initial direction of the project was to develop and implement a research-based protocol to de-label hospitalized patients with a patient-stated penicillin allergy who were not truly allergic (Phase I). The project was abruptly halted due to the lack of data to justify the need, lack of sufficient communication among stakeholders, questions regarding financial cost of implementation, and strong concerns regarding educational needs of nursing staff. After developing the initial protocol, the project team was redirected to provide evidence-based allergy assessment education to the nursing staff to foster reliable and accurate patient interviews and documentation of the results (Phase II). …

Effect Of Nurse-Developed Dyspnea Improvement Education On Home Health Patients, Teresa Gough, Nevin Ozyurt

Doctor of Nursing Practice Projects

In home health patients, dyspnea is one of the quality indicators on the Medicare Outcome and Assessment Information Set (OASIS). Any home health agency that is seeking Medicare certification is required to meet Medicare Conditions of Participation, including compliance with OASIS data collection and transmission of data (Centers for Medicare and Medicaid Services, 2012). At a hospital affiliated home health agency in the Midwest, between November 2015 and October 2016, 82.85% of patients admitted for services received Medicare coverage (Memorial Home Services, 2016). Due to the high Medicare population seen by this home health agency, it is important to show …

Effects Of Transitional Care Management On Hospital Readmissions, Samantha Dunkirk

Doctor of Nursing Practice Projects

Primary care providers are challenged to identify strategies to decrease hospital readmissions. Transitional care management (TCM) services can improve communication and allow primary care providers (PCP) an opportunity to meet with patients just after discharge to assess needs and prevent readmissions. A TCM protocol was evaluated at a large Midwestern clinic to determine if communication improved and readmissions decreased. The protocol consisted of notifying the PCP upon admission and discharge to the hospital, communicating with the patient or family within 48 hours of discharge, and facilitating a follow up visit with the primary care provider within 14 days of hospital …

Diabetic Foot Screening Tool: Utility In A Busy Primary Care Setting, Crystal A. Cusanelli

Doctor of Nursing Practice Projects

Abstract

Problem: Providers in a Midwest rural clinic identified that foot care is often overlooked due to the complexity of diabetic patients and limited time available during office visits.

Purpose: This project examined the utility of an evidence-based, diabetic foot screening tool, provider satisfaction with the tool, and provider perceptions regarding foot care in a busy primary care practice.

Methodology: Providers were instructed on using the screening tool. The tool was utilized on all diabetic patients during office visits over a two-month period. Anonymous surveys were distributed and a focus group was conducted to gather post-implementation outcomes.

Results: Two providers …